Provider Demographics
NPI:1508621491
Name:IVEY, HEATHER M (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:IVEY
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AUTUMNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7866
Mailing Address - Country:US
Mailing Address - Phone:505-350-8192
Mailing Address - Fax:
Practice Address - Street 1:8500 MENAUL BLVD NE STE B460
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2250
Practice Address - Country:US
Practice Address - Phone:505-974-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist